POST OPERATIVE ROTATOR CUFF REPAIR PROTOCOL. Home Program

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1 MOON SHOULDER GROUP For information regarding the MOON Shoulder Group, speak to your surgeon or contact: Rosemary Sanders 4200 Medical Center East st Avenue South Vanderbilt University Medical Center Nashville TN POST OPERATIVE ROTATOR CUFF REPAIR PROTOCOL Home Program Version 1.0 All Illustrations by Jasper Richardson. 20

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3 Rehab Diary Using the diary, please keep track each time you do therapy for your shoulder. Please answer whether you do your therapy with a therapist or at home for each day. If you have comments, please write them on the diary. Introduction The MOON Shoulder Group is a group of shoulder experts who study the best ways to treat patients with rotator cuff tears. The treatment program in this book is based on the best available evidence. When no information was available, the MOON Shoulder Group experts came up with an agreement for treatment. Do not add or skip any part of this program. If you have concerns, please contact your doctor. GENERAL INSTRUCTIONS: Icing Patients are urged to ice after surgery. Sling Use A sling with a small pillow is to be worn for six weeks after surgery. The sling may be taken off for showering, therapy, driving, and deskwork. The sling should be worn when in an uncontrolled setting: sleeping, around children, pets, and crowds during these six weeks. Exercise Program Therapy is to begin within 7 days after surgery. Exercises should be done once per day either at home or with a therapist. The exercise program is divided into four sections. Do not move into the next section until the correct time after surgery. 18

General Instructions WOUND CARE After surgery, you will have heavy bandages that may be taken off after 24 hours. If you notice some fluid leaking, you may put on another heavy bandage.

To wash the underarm area, lean forward and let the arm hang in front of you. It is all right to allow water to run across your wound, which is protected by the strips.

4 General Instructions WOUND CARE After surgery, you will have heavy bandages that may be taken off after 24 hours. If you notice some fluid leaking, you may put on another heavy bandage. Under the bandage, you may have thin strips of tape over your wound. Do not remove the strips. They will fall off by themselves. You may shower 48 hours after surgery. To wash the underarm area, lean forward and let the arm hang in front of you. It is all right to allow water to run across your wound, which is protected by the strips. DO NOT get into a bathtub, pool, or spa until your sutures are removed and your wound is completely healed to lower the chance of skin infection. Always wash your hands before touching your wound. DO NOT use any anti bacterial creams on your wound. Please contact your doctor immediately if you notice any of the following as these could be a sign of an infections: 1) Fluid leaking from the wound; 2) A foul odor from the wound; 3) Any redness or warmth around the wound; or 4) Increased pain. In addition, please check your temperature if you begin to feel ill, warm, or if you have chills. Contact your doctor immediately if your temperature is above 101 degrees or you think you may have an infection anywhere in your body. It is common to have a low temperature within the first week of surgery. You should drink fluids and breathe deeply. 4 Phase 4: Resisted Exercises (12 16 Weeks after Surgery) Phase 4: Resisted Exercises Weeks. These exercises include light stretching. SHOULDER STRETCHING Stretching should be done daily. Hold each stretch for 15 seconds, rest for 15 seconds, and repeat 5 times. Begin with gentle stretching. After 16 weeks, aggressive stretching may be used if needed. Place hands or forearms at shoulder level in a corner of a room. Lean forward into corner and hold. Bring injured arm across front of body. Hold elbow with other arm. Gently flex the bent arm which will pull the other arm across the chest until a stretch is felt in the back of the shoulder. Hold injured arm over shoulder with towel. Hold bottom of the towel with healthy arm. Slowly pull downward with healthy arm until gentle stretch is felt in back of shoulder. Lie on your side on a flat surface. Bring injured arm across the front of your body. Push down on hand towards table. Gently pull across chest until a stretch is felt in the back of shoulder.

Phase 4: Resisted Exercises (12 16 Weeks after Surgery) Phase 4: Resisted Exercises 12 16 Weeks. These exercises are for strengthening.

General Instructions SWELLING AND BRUISING It is common to have swelling and/or bruising after surgery. This is caused by bleeding and is expected.

You may also have some swelling in your hand which should go away; squeezing a ball or making a fist repeatedly will help with this. In time, the swelling will go away. Stand straight up.

Lie on your back, elbow locked straight, arms stretched up towards the ceiling with weights in hand. Push arms up towards the ceiling as far as possible.

5 Phase 4: Resisted Exercises (12 16 Weeks after Surgery) Phase 4: Resisted Exercises Weeks. These exercises are for strengthening. RESISTED SCAPULA STRENGTHENING Strengthening exercises should be done times, followed by 2 minutes of rest, and repeated as 3 4 sets. These should be done 3 days each week. General Instructions SWELLING AND BRUISING It is common to have swelling and/or bruising after surgery. This is caused by bleeding and is expected. The bruising may start out black red purple that will change to a yellowishgreen color as it fades over a few weeks. The bruising may go down the arm. You may also have some swelling in your hand which should go away; squeezing a ball or making a fist repeatedly will help with this. In time, the swelling will go away. Stand straight up. Keep your elbows straight while pulling the elastic band backwards, trying to reach behind you. Fasten elastic to a stable object, pull elastic back and squeeze shoulder blades together. Lie on your back, elbow locked straight, arms stretched up towards the ceiling with weights in hand. Push arms up towards the ceiling as far as possible. Slightly bend hips and knees and support upper body with other arm as shown. Lift arm up, raising elbow to shoulder height. 16 DISCOMFORT You may need help with your daily activities, so it is a good idea to have family and friends around to help you. You will have some mild to moderate shoulder discomfort. Please take your pills as told by your doctor and remember to use your cooling device to help reduce pain. If you have pain that your pain pills do not take care of, please contact your doctor s office. NAUSEA AND VOMITING It is common to have nausea and/or vomiting for the first 24 hours after surgery. Please contact your doctor s office about any nausea/vomiting that does not go away. You may eat whatever you wish, however, it is suggested that you start with fluids and bland food before moving to your regular diet.

General Instructions Phase 4: Resisted Exercises (12 16 Weeks after Surgery) YOUR MEDICATIONS You should start taking all your usual pills right after surgery.

BLOOD CLOTS Surgery may slow the blood flow in your legs, which might (rarely) cause a blood clot to form in the leg.

Walking regularly early after surgery can prevent blood clots. Moving the ankle a lot and rising up on your toes can lower the risk of this problem.

Phase 4: Resisted Exercises 12 16 Weeks. After 12 weeks, the patient can begin strengthening. Resisted exercise uses elastic bands and/or hand weights.

ROTATOR CUFF STRENGTHENING With the arm tucked close to the body, pull the rubber tubing across your stomach.

You may also lie on your healthy side with your injured side arm up, and your elbow bent holding a hand weight; move your hand away from your belly.

6 General Instructions Phase 4: Resisted Exercises (12 16 Weeks after Surgery) YOUR MEDICATIONS You should start taking all your usual pills right after surgery. If there are exceptions to this, your doctor will tell you. If you have questions contact your doctor s office. BLOOD CLOTS Surgery may slow the blood flow in your legs, which might (rarely) cause a blood clot to form in the leg. If a clot were to form, the leg is usually painful and swollen. Blood clots can be serious and if you have one, you will need to go to the hospital. Walking regularly early after surgery can prevent blood clots. Moving the ankle a lot and rising up on your toes can lower the risk of this problem. Please contact your doctor right away if: You have swelling, tenderness, pain, warmth or redness in your thigh, calf, or ankle. Phase 4: Resisted Exercises Weeks. After 12 weeks, the patient can begin strengthening. Resisted exercise uses elastic bands and/or hand weights. These should be done 3 days per week. Each exercise should be done times followed by 2 minutes of rest, and repeated 3 4 times. ROTATOR CUFF STRENGTHENING With the arm tucked close to the body, pull the rubber tubing across your stomach. Turn around to pull the tubing away from your stomach. You may also lie on your healthy side with your injured side arm up, and your elbow bent holding a hand weight; move your hand away from your belly. Do times, for 3 4 sets, for 3 days/week. Call 911 if you have signs that might mean a blood clot that has moved to your lungs: Chest Pain Trouble Breathing Rapid Breathing Sweating Confusion 6 DELTOID STRENGTHENING With the arm tucked close to the body, pull rubber tubing while doing forward punches. Turn around pull the tubing to the body. Do times, for 3 4 sets, for 3 days/week. DO NOT DO FULL CAN OR EMPTY CAN EXERCISES! These place too much stress on the shoulder.

Phase 3: Isometric Exercise (8 12 Weeks after Surgery) General Instructions Phase 3: Isometric Exercises 8 12 Weeks Beginning 8 weeks after surgery the patient can begin isometric exercises.

ISOMETRIC PUSH AND PULL With a pillow against the wall, and the arm tucked close to the body, push forward with the fist, and push backward with the elbow.

Activity Limits Showering: 48 Hours Deskwork: When comfortable with sling Driving: 6 weeks Using arm for Activities of Daily Living: 6 weeks Using arm to reach overhead: 12 weeks Using arm to reach

surgery. Exercises should be done each day at home or with a therapist. The program is four sections. Do not move on to the next section until the correct time after surgery.

7 Phase 3: Isometric Exercise (8 12 Weeks after Surgery) General Instructions Phase 3: Isometric Exercises 8 12 Weeks Beginning 8 weeks after surgery the patient can begin isometric exercises. Using a pillow or folded towel the patient pushes against the wall without moving the shoulder. ISOMETRIC PUSH AND PULL With a pillow against the wall, and the arm tucked close to the body, push forward with the fist, and push backward with the elbow. Hold while pushing for 15 seconds then rest for 30 seconds. Repeat this times. This can be done daily. Activity Limits Showering: 48 Hours Deskwork: When comfortable with sling Driving: 6 weeks Using arm for Activities of Daily Living: 6 weeks Using arm to reach overhead: 12 weeks Using arm to reach behind back: 6 weeks Using arm to carry objects: 6 weeks Pushing/Pulling: 6 weeks Sport/Heavy Activity: When finished with therapy program Exercise Program Therapy is to begin within 7 days after surgery. Exercises should be done each day at home or with a therapist. The program is four sections. Do not move on to the next section until the correct time after surgery. Rehab Diary Please keep track of therapy visits and exercises done at home in Rehab Diary. Please bring the diary to each visit. Questions/Concerns If you have questions or concerns, please contact your doctor. ISOMETRIC EXTERNAL AND INTERNAL ROTATION With a pillow against a wall, and the arm tucked close to the body, push against the wall with the back of the hand, and with the palm of the 14 hand. Hold while pushing for 15 seconds then rest for 30 seconds. Repeat this times. This can be done daily.

Phase 3: Active Motion (8 12 Weeks after Surgery) Phase 3: Active Range of Motion 8 12 Weeks

Raise the arm(s) up in front of the body and up and to the side.

ACTIVE RANGE OF MOTION While sitting up or standing, move the injured arm in front of the body

8 Phase 3: Active Motion (8 12 Weeks after Surgery) Phase 3: Active Range of Motion 8 12 Weeks While still working on active assisted range of motion, active range of motion begins. Raise the arm(s) up in front of the body and up and to the side. These exercises can be done daily. ACTIVE RANGE OF MOTION While sitting up or standing, move the injured arm in front of the body and to the side of the body. 8 ACTIVE RANGE OF MOTION It is important to not hike the shoulder. Place the hand from the healthy arm on the injured shoulder, or do these in front of a mirror to avoid this.

Phase 2: Active Assisted Motion (5 8 Weeks after Surgery) Phase 2: Active Assisted Range of Motion 5 8 Weeks Five weeks after surgery the patient s back is propped up on a

After six weeks, these exercises can be done while sitting up or standing. These exercises can be done daily.

The therapist will move the arm through a comfortable range of motion while the patient is lying down.

These exercises are done with each therapy visit, three times each week. Plus, pendulum exercises can be started during this time. These can be done at home, twice each day.

The arm is moved in up and in front of the body, to the side of the body, and up and to the side. This begins 5 weeks after surgery and is done daily.

body, and up and to the side while sitting up or standing. Using pulleys while sitting 12 in a chair is also allowed at this time. These exercises should be done daily.

9 Phase 2: Active Assisted Motion (5 8 Weeks after Surgery) Phase 2: Active Assisted Range of Motion 5 8 Weeks Five weeks after surgery the patient s back is propped up on a pillow. Using the healthy arm to move the injured arm with a cane or stick, the arm is moved up and in front of the body, to the side of the body, and up and to the side. After six weeks, these exercises can be done while sitting up or standing. These exercises can be done daily. Phase 1: Passive Motion (0 4 Weeks after Surgery) Phase 1: Passive Range of Motion 0 4 Weeks Passive range of motion starts within 7 days after surgery. The therapist will move the arm through a comfortable range of motion while the patient is lying down. Motions include raising the arm in front of the body, turning the arm out to the side of the body, and raising the arm up and to the side all within a comfortable range. These exercises are done with each therapy visit, three times each week. Plus, pendulum exercises can be started during this time. These can be done at home, twice each day. 45 DEGREE ACTIVE ASSISTED RANGE OF MOTION While propped on a pillow using a stick or cane, the healthy arm will move the injured arm over the head. The arm is moved in up and in front of the body, to the side of the body, and up and to the side. This begins 5 weeks after surgery and is done daily. UPRIGHT ACTIVE ASSISTED RANGE OF MOTION Six weeks after surgery using a stick or cane, the healthy arm will move the injured arm up and in front of the body, to the side of the body, and up and to the side while sitting up or standing. Using pulleys while sitting 12 in a chair is also allowed at this time. These exercises should be done daily. PASSIVE RANGE OF MOTION The patient lies flat and relaxes. The therapist will move the arm. The patient should relax and should not flex any muscles while the therapist moves the arm. This should be done at each therapy visit, three times each week. PENDULUM EXERCISES Use the upper body to move arm by rocking the body. Go in a clockwise direction then counter clockwise. These exercises can be done twice each day.

Phase 1: Scapula Exercises (0 12 Weeks after Surgery) Phase 2: Active Assisted Motion (4 Weeks after Surgery) Phase 1: Scapula Stabilizer Exercises These exercises begin

These exercises should include raising the shoulders, lowering the shoulders, pressing the shoulder together, and apart.

Phase 2: Active Assisted Range of Motion 4 Weeks 4 weeks after surgery the second phase starts with active assisted range of motion.

toward the spine, and apart. Practice upright posture. LYING ACTIVE ASSISTED FORWARD ELEVATION Using a stick or cane, the healthy arm will move the injured arm over the head.

10 Phase 1: Scapula Exercises (0 12 Weeks after Surgery) Phase 2: Active Assisted Motion (4 Weeks after Surgery) Phase 1: Scapula Stabilizer Exercises These exercises begin within 1 week, and are done while the arm is in the sling. These exercises should include raising the shoulders, lowering the shoulders, pressing the shoulder together, and apart. Six weeks after surgery, these can be done out of the sling until strengthening exercises begin, 12 weeks after surgery. These can be done daily. Phase 2: Active Assisted Range of Motion 4 Weeks 4 weeks after surgery the second phase starts with active assisted range of motion. The patient lies flat and uses the healthy arm (or a stick or cane) to move the injured arm up in front of the body, to the side beside the body, and up and to the side. These can be done daily. SCAPULA EXERCISES WITH SLING 0 6 WEEKS AFTER SURGERY While sitting or standing and wearing the sling bring shoulder up as you shrug, down as you lower the shoulder, together toward the spine, and apart. Practice upright posture. These can be done daily. LYING ACTIVE ASSISTED FORWARD ELEVATION Using a stick or cane, the healthy arm will move the injured arm over the head. LYING ACTIVE ASSISTED EXTERNAL ROTATION Keep the injured arm tucked close to the body. Bend the elbow so the hand is pointed to the ceiling. Using a cane, the healthy arm moves the injured arm away from the body. SCAPULA EXERCISES WITHOUT SLING 6 WEEKS AFTER SURGERY 10 After six weeks, these can be done without the sling, with the arm at the side. These can be done daily. LYING ACTIVE ASSISTED ABDUCTION While keeping the elbow of the injured arm straight, the healthy arm will move the injured arm out to the side of the body as high as comfortable.

POST OPERATIVE ROTATOR CUFF REPAIR PROTOCOL. Home Program MOON SHOULDER GROUP

POST OPERATIVE ROTATOR CUFF REPAIR PROTOCOL. Home Program MOON SHOULDER GROUP MOON SHOULDER GROUP For information regarding the MOON Shoulder Group, speak to your surgeon or contact: Rosemary Sanders 4200 Medical Center East 1215 21st Avenue South Vanderbilt University Medical Center